肥胖对巴西利什曼原虫引起的皮肤利什曼病临床表现和治疗反应的影响。
Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis Caused by Leishmania braziliensis.
机构信息
Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.
Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.
出版信息
Clin Infect Dis. 2021 Sep 15;73(6):1020-1026. doi: 10.1093/cid/ciab236.
BACKGROUND
Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response.
METHODS
A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days.
RESULTS
Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (P < .05).
CONCLUSIONS
Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.
背景
由巴西利什曼原虫引起的皮肤利什曼病（CL）的特征是单个溃疡或多个皮肤病变，边界隆起。接受葡甲胺锑治疗后，治愈率<60%。我们研究了肥胖对 CL 临床表现和治疗反应的影响。
方法
共纳入 90 例年龄匹配的 CL 患者（30 例肥胖，30 例超重，30 例 BMI 正常）。通过聚合酶链反应记录巴西利什曼原虫 DNA 或在活检皮肤病变样本中鉴定无鞭毛体来诊断 CL。通过化学发光法测定血清细胞因子水平。用 Glucantime（赛诺菲-安万特；20mg/kg/天）进行 20 天的锑治疗。
结果
肥胖的 CL 患者可能表现为肥厚性溃疡，而不是典型的椭圆形、溃疡性病变。BMI 与愈合时间呈直接相关。在 1 个疗程的锑治疗后，正常 BMI 的患者中有 73%、超重患者中有 37%治愈，但肥胖的 CL 患者仅有 18%治愈（P<0.01）。肥胖的 CL 病例的瘦素水平高于超重患者或 BMI 正常的患者（P<0.05）。
结论
肥胖改变了 CL 的临床表现和宿主免疫反应，并与治疗失败率增加有关。
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